Nov. 27: Did Ramsey County workhouse nurses neglect inmate with TB?

When Marchello McCaster was booked into the Ramsey County workhouse to serve 56 days on an assault conviction, he weighed 200 pounds and was healthy enough to play basketball with the other inmates.

But by the time he left in July 2008, McCaster had lost 44 pounds and was nearly dead from tuberculosis, Robert Bennett told jurors in a St. Paul federal courtroom Tuesday.

Bennett said the defendants -- three experienced public health nurses who worked at the jail -- stubbornly ignored his client's worsening symptoms as well as pleas from other inmates who sought help for him. McCaster was finally rushed to Regions Hospital in St. Paul after a guard demanded that a nurse evaluate him just two days before he was due for release. "He has a softball-sized hole in one lung, as well as a baseball-sized hole in the other," Bennett said.

McCaster's illness led to about 150 infections among inmates and jail staff. Public health nurses are trained to watch for signs of infectious diseases like tuberculosis, Bennett said, because in confined settings, "Everyone counts, or no one counts."

Related suit settled

Ramsey County settled an earlier class-action lawsuit related to the TB outbreak estimated to cost up to $20 million. McCaster separately filed suit against five nurses, the county and two administrators seeking $14 million in damages. The charges against all but three nurses were dropped or dismissed.

A jury of six women and two men must now decide whether the remaining defendants -- Mary Clausen, Julie Nelson and Pattie Vodinelich -- showed something akin to "criminal recklessness" for failing to seek medical help for McCaster, who was already infected when he arrived at the jail on April 17, 2008.

Clifford Greene, one of the defendants' attorneys, told the jurors that McCaster, 30, of St. Paul, never complained of symptoms indicating TB, and the nurses deny allegations that they were shown notes from other inmates that might have triggered a thorough medical evaluation.

Clausen didn't interact with McCaster until he complained of an abscessed tooth and sore feet more than a month after he was admitted to the workhouse, Greene said. She arranged for a prescription of penicillin and ibuprofen for his toothache, gave him the initial dose, and said to come back if needed, Greene said. She advised him to change shoes to alleviate his sore feet. He said the evidence will show that McCaster's TB symptoms didn't surface until later.

Experts on both sides

Both sides are expected to call expert witnesses. Bennett said McCaster's symptoms would have been obvious even to an untrained eye. Greene said TB symptoms come and go and are not always apparent even to trained medical personnel.

Nelson never had a chance to evaluate McCaster, Greene said. She worked the night shift, and her only contact with him was through a small, waist-high window when he lined up with about 100 other inmates to pick up his medication. She will testify that she saw Clausen with some notes, presumably from inmates, but didn't read them and doesn't know what they said.

"That's it. There's nothing more of Julie Nelson in this case," Greene said.

Greene described Vodinelich as a dedicated caregiver who had just one significant interaction with McCaster. After a guard insisted that she evaluate McCaster, she did so, then arranged for his transfer to Regions, where he was diagnosed with advanced-stage tuberculosis and related disorders, Greene said.

Nelson, Vodinelich and Clausen were among eight nurses who dispensed medicine at the jail, but those brief transactions didn't allow for medical evaluations, he said.